Constant dizziness and its causes

A.D. Solovyova

Department of Pathology of the Autonomic Nervous System of the Moscow Medical Academy named after I.M. Sechenov

Dizziness is one of the most common complaints: at a visit to a general practitioner, complaints of a feeling of dizziness are detected in 5% of patients, and by an otolaryngologist - in 10% (W. Osterveld, 1991).

Dizziness is a symptom and is never a disease. W. Osterveld (1985) described about 80 diseases that have dizziness as a symptom; in 40% of cases the cause was difficult to establish. Dizziness can be a symptom of a wide variety of diseases: neurological, mental, cardiovascular, eye, ear and other somatic suffering.

Patients with dizziness as a leading symptom are considered “difficult” both in diagnostic and therapeutic terms. Dizziness, like pain, fear or depression, is a subjective complaint of the patient. When telling a doctor about dizziness, the patient may mean a wide variety of sensations - a feeling of spinning, falling, moving his body or surrounding objects, a state of lightheadedness, general weakness and a premonition of loss of consciousness, as well as instability when walking and gait disturbances.

Definition and Features

It is necessary to distinguish between true dizziness, in which there is a feeling of objects moving in space. Such symptoms may be normal if they occur after prolonged rotation around its axis (on a carousel), but in other cases they indicate a malfunction of the vestibular apparatus. The difficulty in diagnosing this condition is that the doctor has to rely only on the patient’s testimony. Many people also mean other symptoms by this term: impaired visual acuity, headaches and others. In reality, dizziness should be understood as a feeling of movement of environmental objects in relation to a person, while the body position is felt as stable. Most often these are circular movements (objects rotate around a person’s axis), but they can also be linear (a feeling of falling or rising in height, various shocks).

Anatomy and mechanism of development of pathology

With dizziness, there is a growing lack of coordination of movements and balance. To find out its cause, one must understand how the transmission of nerve impulses that play a role in proprioception occurs. This term refers to a person’s ability to identify and sense the position of parts of his own body relative to each other and objects in the environment. Information is perceived by proprioceptor organs, including muscle tissue, and then moves along peripheral nerves to the spinal cord, from where it enters the brain. The necessary picture is formed in the parietal lobe of the brain after nerve impulses pass through the thalamus.

The inner ear is an organ that is responsible for a person's ability to maintain balance. It has a complex structure and consists of several sections: the vestibule, 3 semicircular canals and the cochlea. The inner ear is protected by bone tissue that forms the temporal lobe of the skull. It is filled with aqueous fluid - it moves when a person tilts and turns his head, and this information is perceived by sensitive cells to identify the position of the body in space.

The nervous system collects information that comes from the visual apparatus, tactile receptors and other sensory organs, as well as from the inner ear, and then analyzes it. The center of balance is located in the cerebral cortex, namely in its temporal region. Along the nerves, impulses reach the vestibular nuclei - clusters of nerve cells capable of perceiving, analyzing and coordinating information received from different areas.

Dizziness is a disturbance in the sense of balance. Anatomically, it can occur at several levels:

• peripheral - in case of disturbance of impulse conduction at the level of the vestibular nerve or inner ear (organ of balance);
• intermediate - the pathological process is localized at the stage of transmitting information from the inner ear to the central nervous system;
• central - associated with diseases of the brain, in which it is unable to analyze the information received.

Clinical signs of dizziness of different origins do not differ. The patient experiences a feeling of disorientation in space and abnormal movement of environmental objects. However, short-term loss of balance cannot be a consequence of serious diseases of the cerebral cortex. Such dizziness is accompanied by a number of additional symptoms and occurs after injury or certain diseases. To diagnose the cause and mechanism of development of this symptom, doctors at the Clinical Institute of the Brain carry out a comprehensive examination to determine accompanying symptoms.

Features of the ataxic gait

Due to imbalances, patients with pathological processes in the cerebellum try to increase the area of ​​support, spread their legs widely, stagger and sway randomly when walking.
Movements of the upper and lower extremities lose synchrony. Instability persists in a standing position, regardless of the presence or absence of visual control. With unilateral damage to the cerebellum, one half of the body suffers, and falls on the affected side are possible. When cortical structures are involved, the clinical picture resembles that of cerebellar ataxia. Instability increases when turning, the patient often “falls” in the direction of the lesion, unsteadiness of gait correlates with the severity of the damage to the cortex. In people with damage to the ventrolateral thalamus, unsteadiness and instability occur on the opposite side, and there is a tendency to fall backward or to the healthy side.

Forms of dizziness

To more accurately determine the cause of dizziness, there are several classifications of this symptom. This distribution is necessary to understand the danger of the disease and to prescribe an effective treatment regimen. Various types of therapy can be carried out by doctors of different specialties. Thus, the first classification distinguishes two types of dizziness: systemic and non-systemic.

1. Systemic dizziness is a more dangerous type, which in any case indicates pathology. It is associated with a violation of nerve conduction at the level of the vestibular apparatus (inner ear, vestibular nerve, parts of the cerebral cortex). Systemic dizziness can be central, intermediate or peripheral, depending on the location of the pathological process.
2. Non-systemic dizziness is also called physiological. It manifests itself in the absence of pathological changes in the vestibular apparatus, but may be a consequence of its excessive irritation. Thus, non-systemic dizziness is one of the clinical signs of motion sickness syndrome, and also occurs after a long and monotonous rotation around its axis.

Symptoms of dizziness may vary. In this regard, it is also customary to distinguish several of its varieties:

• tactile - the patient experiences a sensation of loss of support under his feet, instability, as on a ship;
• proprioceptive - associated with a change in the identification of the body in space, with a feeling that the body is rotating around an axis, and the surrounding objects remain in their places;
• visual - visually the human body remains motionless, and the environment begins to move in different projections.

It is worth understanding that systemic dizziness manifests itself in a more vivid clinical picture. It is associated with damage to neural connections, so symptoms appear and remain even without an apparent reason. In addition, loss of balance is accompanied by other characteristic manifestations of damage to the nervous system or analyzer systems. Non-systemic dizziness is temporary and can go away spontaneously as soon as the vestibular system adapts to environmental changes. The second case does not pose a danger to humans.

Diagnosis of dizziness

In order to determine whether a person is experiencing true or systemic vertigo, it is necessary to ask the patient to describe in detail a typical attack. With statements such as: “It seemed to me that the room was spinning around me,” one can confidently judge the presence of dizziness. It is important to have accompanying symptoms such as nausea and vomiting. When collecting anamnesis, it is necessary to note the duration of dizziness and the connection with changes in position. It should also be remembered that a number of antihypertensive, antiepileptic, antirheumatic and other drugs can cause side effects in the form of dizziness.

There are simple diagnostic tests to detect dizziness. First of all, it is necessary to measure the patient's blood pressure (BP) in a lying and standing position. A significant decrease in blood pressure in an upright position indicates the presence of orthostatic hypotension and suggests that the patient’s symptom is not true dizziness, but is associated with lipothymia, when the patient suddenly stands up.

To assess the maintenance of balance, the Romberg test is traditional.

An important diagnostic criterion is the detection of nystagmus. Nystagmus is an involuntary rhythmic vibration of the eyeballs. Nystagmus can be observed if the patient holds his head straight while moving the eyeballs to the sides. Nystagmus can also be triggered by changes in head position.

During a special examination by an ENT doctor, temperature tests are used when the external auditory canal is irrigated with water at a temperature 7°C higher or lower than blood temperature. Temperature tests may provoke a sensation of rotational motion and nystagmus. Nystagmus is observed during dizziness and is an objective criterion for the presence of true dizziness. The duration of nystagmus can be recorded using electronystagmography. Finally, rotation testing is used, in which the patient is rotated on a special chair around a vertical axis and the movements of the eyeballs are recorded.

Recently, a method for studying the tracking function of the eyes in the background and in the absence of visual interference, as well as against the background of orientation illusions and vestibular stimulation, has proven to be promising. The vestibular and visual systems closely interact in their functioning, and the nature of their interaction determines the accuracy of tracking a visual object. Changes in vestibular function necessarily affect all forms of visual tracking. In the laboratory of vestibular physiology of the Institute of Biomedical Problems of the Russian Academy of Sciences, a method was developed for determining the functional state of the oculomotor system using computer stimulation programs (L.N. Kornilova et al., patent No. 1454374).

Main causes of the symptom

Dizziness can be a symptom of a number of diseases and pathological conditions that lead to disruption of the vestibular apparatus. These are congenital or acquired disorders of varying severity, with different mechanisms of development and characteristics of clinical manifestations. Among the most common groups of causes of this symptom are the following:

• inflammatory diseases of the inner ear and vestibular nerve - can be of infectious or non-infectious origin;
• intoxication and poisoning, which lead to disruption of the vestibular apparatus;
• traumatic brain injuries - when certain areas of the cerebral cortex are damaged, dizziness may appear after a long time;
• metabolic disorders, including diabetes.

Impaired balance and coordination of movements in space can also be a variant of the norm. In some cases, intense irritation of the vestibular apparatus occurs (on a carousel, during a long stay on a ship or on another unstable support), after which the nervous system needs time to recover. It is impossible to determine the cause of dizziness at home, especially if it is a consequence of organic lesions of the central nervous system.

Why does a shaky gait occur?

Hereditary diseases

Atactic gait is a constant or possible symptom of some hereditary pathologies:

• Ataxia of Pierre-Marie.
  Unsteady gait and other manifestations of ataxia occupy a leading place in the clinical picture of the disease, complemented by oculomotor and visual disturbances, and mental disorders of a neurotic level.
• Friedreich's ataxia.
  A progressive degenerative disease that manifests itself in the third decade of life. The symptom occurs at the initial stage, and is subsequently supplemented by dysarthria, paresis and muscle atrophy.
• Spinocerebellar ataxia.
  A group of hereditary pathologies in which an unsteady gait and clumsiness of movements are detected in combination with parkinsonism and optic nerve atrophy.
• Olivopontocerebellar degenerations.
  Ataxic gait is considered as a basic sign of pathology, complemented by hyperkinesis, secondary parkinsonism, cognitive and mental disorders.
• Wilson-Konovalov disease.
  The sign is optional, detected in a rare extrapyramidal-cortical form, combined with severe intellectual deficit, pyramidal disorders, and epileptic seizures.

Circulatory disorders

The cause of an ataxic gait may be ischemia or hemorrhage. Possible provoking factors are cerebral atherosclerosis, arteriovenous malformations, and other vascular disorders. In most cases, the pathology develops acutely, and the clinical picture of a stroke is revealed. Less commonly, for example, with Kimerli’s anomaly, cerebellar symptoms progress gradually.

The involvement of cerebellar structures is indicated by a decrease in muscle tone on the affected side, macrography, and extended scanned speech. When cortical structures are damaged, characteristic mental changes and olfactory disorders are detected. The grasping reflex is determined. There is no hypotonia of the muscles of the affected half of the body.

Ataxia

Tumors

Among oncological diseases, the most significant role in the occurrence of ataxic gait is played by cerebellar tumors. The clinical picture is variable and includes ataxia, general cerebral symptoms, and signs of brainstem compression. The listed groups of symptoms can occur either simultaneously or sequentially. A shaky gait is combined with dizziness, cephalalgia, and vomiting of central origin. General cerebral symptoms are especially pronounced when the outflow of cerebrospinal fluid is obstructed.

Cerebellar disorders tend to increase and spread. When the tumor is located in one hemisphere of the cerebellum, difficulties in maintaining balance are observed on one side; as the neoplasia grows, bilateral coordination disorders begin to predominate. Involvement of the trunk is indicated by strabismus, neuritis of the trigeminal and facial nerves, hearing loss, and oculomotor disorders.

With neoplasms of the cerebral hemispheres, dizziness occurs later than with neoplasia of the cerebellum. During an ophthalmological examination, congestive optic discs are detected on both sides. There is a high prevalence of mental pathologies - from mnestic and emotional disorders to delusions and hallucinations.

Traumatic injuries

Unsteady gait becomes a consequence of intracranial hematomas of the corresponding localization, compression of the frontal lobes by subdural and epidural hematomas. In acute hematomas, symptoms develop within a few hours or days, in chronic hematomas - over weeks, months or years. Possible headaches, dizziness, vomiting not associated with food intake, epileptic seizures, “frontal” mental disorders with elevated mood, ridiculous behavior and decreased criticism.

Brain abscesses

The clinical picture of the abscess is consistent with other space-occupying lesions of the cortex or cerebellum; there are no specific symptoms. The infectious nature of the process is indicated by the presence of injuries and operations on brain structures, purulent-inflammatory lesions of the ENT organs, an acute onset with signs of intoxication, the rapid formation of an unsteady gait with the subsequent stabilization of neurological disorders after the formation of a capsule that prevents the spread of pus to neighboring structures.

Encephalitis

Balance disorders with the development of an ataxic gait are more typical for secondary encephalitis: influenza, measles, post-vaccination. The risk of developing ataxia increases with severe encephalitis with severe neurological disorders. In some cases, an unsteady gait is detected in patients who have suffered an encephalitic form of tick-borne encephalitis.

Multiple sclerosis

An unsteady gait can be observed already at the onset of the disease, but is not detected in all patients, which is explained by the polymorphism of symptoms, especially in the initial stages. Subsequently, cerebellar pyramidal and sensory disorders form a typical clinical picture of multiple sclerosis. Asynergy of movements, ataxic gait and other symptoms of cerebellar damage are combined with intention tremor and hyperkinesis. Paresis, optic neuritis, and ophthalmoplegia are often detected.

Other reasons

Other pathologies associated with ataxic gait include:

• Multiple system atrophy.
  Unsteady gait, intention tremor and other cerebellar disorders are detected in a third of patients, in 10% of cases they are combined with parkinsonism.
• Intoxication.
  Chronic cerebellar degeneration can be caused by alcoholism, drug addiction and substance abuse. Acute and subacute disorders occur with an overdose of anticonvulsants.
• Endocrine diseases
  . Cerebellar disorders are subacute in nature, with an ataxic gait developing over several weeks or months.
• Paraneoplastic syndrome.
  It is observed in malignant neoplasms of extracerebral localization: ovarian cancer, lung cancer, non-Hodgkin's lymphomas.
• Occlusive hydrocephalus.
  Polyetiological condition with acute or subacute onset. Unsteady gait, intense cephalgia, and frequent nosebleeds are detected.

Clinical picture of different types of dizziness

The main clinical manifestation of dizziness is a feeling of loss of balance and imaginary movement of the body in space. However, this symptom may indicate a number of different disorders, the symptoms of which will differ. At the Clinical Brain Institute, you can undergo a full examination using laboratory and instrumental techniques that will allow you to detect all possible diseases that cause dizziness. However, even an initial examination and medical history will clarify the picture and make a preliminary diagnosis. Systemic dizziness, as a manifestation of functional disorders of the vestibular apparatus, should be considered separately from non-systemic dizziness, which does not pose a danger and can even be considered a variant of the norm.

Systemic dizziness

Systemic dizziness includes a number of diseases associated with various disorders of the conduction of nerve impulses to the cerebral cortex. The pathological process can be located at any level, and therefore the symptoms will differ. Thus, each pathology that may underlie the mechanism of development of dizziness should be considered separately. Systemic types occur in no more than a third of patients and require more detailed examination.

1. Benign paroxysmal positional vertigo (BPPV) is the main cause of systemic varieties. The process is associated with the formation and deposition of crystals of calcium carbonate salts on the tissues of the semicircular canals of the inner ear. This is an acquired chronic disease, the leading clinical sign of which is short-term dizziness and loss of orientation in space. The attacks last no more than 1 minute, with no additional symptoms (headache, tinnitus).
2. Inflammation of the vestibular nerve (vestibular neuronitis) is a dangerous condition that often develops against the background of a bacterial or viral infection. Its reproduction with damage to the nervous system causes a characteristic set of symptoms, which includes dizziness. The duration of their manifestation ranges from several hours to several days, and their intensity remains high or even intensifies. Hearing is preserved in vetibular neuritis.
3. Post-traumatic dizziness is complete or partial disorientation that develops immediately after a traumatic brain injury. The process is associated with damage to areas of the cerebral cortex responsible for transmitting information about the position of the human body in space. Clinical signs may vary in intensity and persist until the tissue has completely healed, and in some cases they appear several days after the injury.
4. Intoxication is another cause of dysfunction of the vestibular apparatus. Toxins, including aminoglycosides, can accumulate in peri- and endolymph, the fluid that fills the structures of the inner ear.
5. Meniere's disease is a disease in which there is an increase in the amount of endolymph (hydrops). The fluid is located in the lumen of the labyrinth of the inner ear, and an increase in its volume leads to excess pressure on its walls. The disease occurs in attacks, the interval between which can range from several days to several months. The duration of one attack is from several hours to a day, and the symptoms are very pronounced. The patient experiences acute disorientation in space, dizziness and headaches. The disease progresses and causes gradual deterioration of hearing (usually a unilateral phenomenon), but complete loss does not occur.
6. Temporal lobe epilepsy is a pathological condition that is manifested by a periodically manifested complex of autonomic disorders (dizziness, headache, low blood pressure, and others). The patient's condition deteriorates suddenly, for no apparent reason, and the attack may be accompanied by deterioration of vision.
7. Lipotymic conditions are a set of symptoms that precede fainting. The patient experiences severe dizziness, weakness, his skin and mucous membranes turn pale, and his heartbeat becomes less frequent. An attack can occur for many reasons, including diseases of the cardiovascular system, a decrease in blood glucose concentration, an increase or decrease in blood pressure.

Systemic dizziness most often occurs in old age, but can also occur in young people. The development of the disease should be monitored over time, taking into account the frequency and intensity of attacks. It is also important to monitor the occurrence of additional signs: hearing and vision impairment, fainting, nausea, migraines. These data will make it possible to determine the severity of violations even before specific analyzes are carried out.

Non-system varieties

One of the most characteristic signs of non-systemic dizziness is that its clinical manifestations intensify if you close your eyes. The causes of this condition may be various dysfunctions of the cerebellum and other structures that regulate motor activity and coordination of movements. Additional clinical signs include general weakness and drowsiness, decreased visual acuity, deterioration of memory and attention. Similar symptoms may occur with systemic use of certain groups of drugs (benzodiazepines). The patient's condition in such cases improves by adjusting the dosage of medications.

Types of dizziness

Dizziness is divided into systemic and non-systemic, as well as into various types. The first type is systemic dizziness. The second type of dizziness is associated with lipotimic states and fainting of various natures. The third type of dizziness is of a mixed nature and represents gait disturbances and instability. The fourth type is psychogenic dizziness. The second, third and fourth types of dizziness are non-systemic in nature. Non-systemic dizziness is observed much more often than systemic vestibular dizziness. It is not associated with damage to the vestubular system itself, it is not characterized by hearing loss, vestubular tests are negative, and, as a rule, nausea, especially vomiting, is not observed.

Systemic dizziness

• The first type - systemic dizziness - is also called vestibular, or true, dizziness, or vertigo. This type of dizziness is manifested by the illusion of rotation of one’s own body or surrounding objects in a certain direction in space, accompanied by vegetative symptoms (nausea, vomiting, increased sweating), a feeling of fear, imbalance and nystagmus. This type of dizziness can be caused by damage to the vestibular system at both the peripheral and central levels.

When the peripheral parts of the vestibular analyzer are damaged, the sensory elements of the ampullary apparatus and vestibule, vestibular ganglion and nerve conductors of the brain stem suffer (A.S. Sheremet, 2001), i.e. Many authors consider the level of suffering of the first neuron to be a peripheral lesion of the vestibular analyzer, and some consider the pathology of the labyrinth only (these are labyrinthitis, Meniere’s disease, vestibular neuronitis, vascular pathology inside the labyrinth, a complication of chronic purulent otitis, etc.). Damage to the vestibular portion between the pyramid and the brain (posterior cranial fossa - PCF) is classified into a special intermediate form (neurinoma of the VII cranial nerve). The cause of peripheral damage to the vestibular analyzer is varied: labyrinthitis of various etiologies - viral and bacterial, exposure to ototoxic antibiotics, thermal, traumatic, thrombosis or hemorrhage in the area of ​​the labyrinthine artery blood supply, destruction of the bone wall by cholesteatoma, trauma to the temporal bone with a pyramidal fracture, blood disease, occupational diseases ( noise, vibration). Often, vestibular dizziness occurs against the background of cervical osteochondrosis with vertebrogenic-basilar insufficiency, with atherosclerosis, thyroid disease, and diabetes mellitus. The labyrinth can be affected by syphilis, HIV infection, pathology of the gastrointestinal tract, vegetative-vascular dystonia, hereditary pathology of the labyrinth, etc.

Meniere's disease

Meniere's disease is a classic example of acute recurrent systemic (vestibular) vertigo and is considered an independent nosological form. In this case, the inner ear is mainly affected. The onset of the disease is sudden or gradual. Dizziness with Meniere's disease can last a long time (up to 12–24 hours). The frequency of attacks ranges from once a year to several times a day. Meniere's disease is characterized by decreased hearing and the presence of autonomic symptoms. The pathogenesis of the disease is still unclear; only the pathomorphological substrate of the disease (endolymphatic hydrops) is known.

Peripheral vertigo is always accompanied by spontaneous nystagmus - horizontal or horizontal-rotatory of varying intensity. The characteristics of nystagmus depend on the position of the eyes: nystagmus increases when looking towards the fast component and weakens towards the slow component. In case of peripheral damage, the eye condition is normal, there is no disturbance of the oculomotor nerves. Most often the process is one-sided and is accompanied by hearing loss. Seizures always occur without loss of consciousness. Peripheral dizziness is characterized by autonomic disorders, which are manifested by nausea, vomiting, pallor, sweating, etc. No pathology is detected during a neurological examination. External factors (light, sound, speech, flickering objects, eye movements) lead to increased dizziness.

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. It is characterized by short attacks of systemic dizziness, which occurs with a certain position of the head and torso, especially when bending back and forth. The patient feels that “the room has moved.” Dizziness lasts a few seconds. There are no neurological symptoms. The course of the disease can be very different. Sometimes the attack is short-lived, occurring once or several times in a lifetime. Only rarely does BPPV persist for a long time. Benign positional vertigo can occur after traumatic brain injury, otitis media or stapedectomy, as well as during intoxication and viral infections. Idiopathic cases of the disease are associated with a degenerative process with the formation of otoconial deposits in the semicircular canal, resulting in increased sensitivity of this canal to gravitational influences when the position of the head changes.

Vestibular neuronitis (acute peripheral vestibulopathy, vestibular neuritis).

It manifests itself as sudden, prolonged dizziness with nausea, vomiting, a feeling of fear and imbalance. Dizziness continues for several days, then weakness and instability develop. Patients tolerate this condition extremely difficult. Spontaneous nystagmus is characteristic, and positional nystagmus is often noted. Hearing is not reduced, but noise and congestion in the ear may occur. In half of patients, attacks recur after several months or years. The cause of the disease is unknown. Vestibular neuronitis is more of a syndrome than an independent nosology.

Labyrinthitis (serous and purulent).

The main causes of damage to the labyrinth are viral diseases, acute and chronic otitis of various etiologies, trauma and surgery. Balance disorders and systemic dizziness are accompanied by hearing loss. In old age, vascular disorders may also occur in the presence of hyper- or hypotension. In these cases, labyrinthitis occurs as a result of a vascular crisis and is accompanied by systemic (vestibular) dizziness and hearing loss. Symptoms gradually regress against the background of pathogenetic therapy.

Neuroma of the statoacoustic nerve (VIII pair of cranial nerve) . The onset of the disease is gradual. Dizziness is rare. Hearing loss occurs quickly when a tumor develops in the internal auditory canal, but more often it is localized in the area of ​​the cerebellopontine angle, and hearing loss develops over years. Neuroma of the VIII nerve in some cases can manifest as acute systemic vertigo, which can lead to an erroneous diagnosis of Meniere's disease, vestibular neuronitis, labyrinthitis, etc. Neuroma is characterized by combined damage to the facial and trigeminal nerves, signs of cerebellar damage, and changes in the fundus. Early examination with the involvement of an otoneurologist, ophthalmologist, and neurologist is necessary, but magnetic resonance imaging has the greatest diagnostic value.

Damage to the vestibular analyzer at the central level can be caused by ischemia of the brain stem, multiple sclerosis, tumors of the PCF, as well as tumors in other parts. Pathological processes developing in the brain lead to disruption of connections between the vestibular apparatus and the cerebral cortex (stem encephalitis, severe intracranial hypertension, vertebrobasilar insufficiency, in degenerative brain disease). With central damage to the vestibular apparatus, vestibulovegetative reactions are in most cases weakly expressed. Hearing loss is not typical.

Vertebrobasilar insufficiency is a common cause of dizziness in older people with vascular risk factors. Dizziness begins acutely, lasts several minutes, and is accompanied by imbalance, nausea and vomiting. The cardinal sign of vertebrobasilar insufficiency are additional symptoms: blurred vision, double vision, dysarthria, falls, weakness and numbness in the limbs. Attacks of dizziness are often the first symptom of vertebrobasilar insufficiency, but if these episodes are repeated over many months or even more years, and other symptoms do not appear, then the diagnosis of vertebrobasilar insufficiency is doubtful. Signs such as osteochondrosis of the cervical spine, sometimes bending of one or both vertebral arteries, detected during ultrasound examination of the vessels of the neck, are also not sufficient grounds for concluding that there is insufficiency of vertebrobasilar circulation. It has now been proven that isolated systemic vertigo, not accompanied by focal neurological symptoms, in the vast majority of cases is a sign of damage to the peripheral parts of the vestibular system.

Unsystematic dizziness

• The second type of dizziness - non-systemic dizziness in the picture of a lipothymic state is characterized by a feeling of lightheadedness (general weakness, nausea), cold sweat, a premonition of falling or loss of consciousness. It is based on lipothymic states or fainting. The cause of syncope can be vasodepressor syncope, hyperventilation syndrome (including psychogenic origin), carotid sinus hyperexcitability syndrome, cough syncope, nocturic, hypoglycemic syncope, orthostatic syncope of various origins). With this type of dizziness, there is often arterial hypotension. Dizziness is accompanied by an asthenic state after acute infectious and somatic diseases, anemia, and acute blood loss.

Unsystematic dizziness occurs with sudden turns of the head, in stuffy rooms, ringing in the ears, and blurred surroundings. A common physiological cause of non-systemic dizziness in women is pregnancy, and among the pathological causes is diabetes. Dizziness of the second type often occurs as a manifestation of peripheral autonomic failure in neurological diseases such as Shy-Drager syndrome and other degenerative diseases of the central nervous system.

To clarify the nature of dizziness and fainting, a cardiac examination is necessary to exclude cardiac pathology. The Danini-Aschner test and the Valsalva maneuver have a certain diagnostic value. These tests indicate increased reactivity of the vagus nerve. Such patients do not tolerate tight collars and stuffy rooms.

• The third type of dizziness is of a mixed nature; this condition is difficult to assess verbally; it occurs when the patient moves and manifests itself in body instability, gait disturbance, and visual or gaze disturbances. The nature of dizziness is heterogeneous and not always clearly defined. This type of dizziness can occur due to pathological processes in the neck area. This includes dizziness with congenital bone pathology (Arnold-Chiari syndrome), with cervical osteochondrosis and osteoporosis (for example, in the picture of posterior cervical sympathetic syndrome), hyperextension, and whiplash injury. The presence of a pathological process in the neck is essential, which can lead to Unterharnscheidt syndrome.

Balance and gait disturbances (dysbasia), associated with paretic, atactic, hyperkinetic, akinetic, apractical or postural disorders, are sometimes perceived and described by patients as conditions reminiscent of vertigo. However, an analysis of the patient’s sensations shows in such cases that the patient may not have dizziness in the literal sense of the word, but there is a decrease in control over his body in the process of its orientation in space.

Dizziness can occur in some people with poorly fitted lenses, and can also be a side effect of certain medications.

• The fourth type is psychogenic dizziness. Complaints of dizziness are among the top ten most common complaints made by patients with psychogenic, namely neurotic, disorders. Psychogenic dizziness is obligately accompanied by severe fear and anxiety, as well as autonomic disorders - cardiovascular and respiratory. Most often, dizziness is observed against the background of hyperventilation syndrome; rapid and shallow breathing leads to metabolic disorders, increased neuromuscular excitability, etc. In this case, patients define their sensations as lightheadedness, lightness of the head, and often the symptoms of dizziness are combined with noise and ringing in the ears, increased sensitivity to sound stimuli, instability when walking.

Psychogenic dizziness often occurs during a panic attack. Symptoms of fear, shortness of breath, palpitations, and nausea may occur simultaneously with symptoms of lightheadedness, lightheadedness, fear of falling, and loss of balance.

An interesting fact is that psychogenic dizziness often occurs in patients with congenital inferiority of the vestibular apparatus, which manifests itself from childhood in the form of poor tolerance to transport, swings, merry-go-rounds, heights, etc. In these cases, vestibulopathy that has existed since childhood takes part in the formation of symptoms in a psychogenic illness and thereby plays an important role in the occurrence of complaints of dizziness.

Diagnostic methods

The Clinical Brain Institute has all the conditions for a full diagnosis of dizziness. The process is carried out by analyzing the work of the vestibular apparatus and the brain, after which the localization of the pathological process and its stage can be detected. During the initial examination, it is important to conduct a detailed interview with the patient and obtain a detailed description of the complaints. At this stage, it is possible to differentiate true dizziness from other conditions that are also often called by this term. Next, specialists will select an individual diagnostic scheme, which may include the following steps:

• examination of the spinal column (analysis of X-rays, CT or MRI) to identify osteochondrosis, vertebral displacements and other pathologies that cause impaired blood supply to parts of the brain;
• examination by a neurologist, which includes determination of nystagmus, various tests and assessment of the ability to coordinate movements;
• examination of the state of the brain using MRI or CT - carried out to exclude tumors and other diseases leading to demyelination of nerve fibers;
• electroencephalography is a way of assessing brain activity by capturing the signals it produces;
• study of the functioning of the vestibular apparatus - may include rotational tests, vestibulometry and other tests.

Instrumental techniques are prescribed after a general examination. Based on the data obtained, the doctor can determine what examinations need to be performed in order to conduct a differential diagnosis and exclude possible causes of dizziness. Thus, if Meniere's disease is suspected, patients are offered a test to detect low-frequency sound signals.

Treatment and prognosis

Specialists at the Clinical Brain Institute will select the most effective treatment regimen, depending on the diagnostic results. In most cases, dizziness does not pose a threat to the life and health of the patient and is easily corrected with general measures and medication. Thus, the following methods of treating the causes and clinical signs of this condition may be recommended:

• constant monitoring of blood pressure indicators, if necessary, taking antihypertensive drugs;
• preventing the appearance of edema - limiting salt intake, prescribing diuretics (diuretics);
• taking vestibulics - drugs to eliminate the symptoms of dizziness;
• if necessary - antihistamines, anti-epileptic drugs;
• restoration of movement coordination with special exercises.

Dizziness is not a disease, but one of the symptoms of a dysfunction of the vestibular apparatus. It is impossible to determine its cause at home, so if it occurs, it is worth undergoing a comprehensive diagnosis at the Clinical Brain Institute. It employs broad and specialized specialists who regularly examine and treat patients with similar symptoms. The medical center also has the opportunity to undergo complex examinations using high-quality equipment necessary to make a diagnosis. Despite the fact that dizziness alone is not a dangerous symptom and cannot threaten the patient’s life, it can indicate serious problems with the vestibular system and organic lesions of the central nervous system in the early stages. It is impossible to cure these pathologies on your own, but an integrated and competent approach in a hospital setting will eliminate both the causes and manifestations of dizziness.